If you want to search Cost Curve back issues or link to anything you read here, the web links and archive are online at costcurve.beehiiv.com. You can subscribe there, too.
I have a note on my desk that reads “Write about smoothing.”
The note has been there for weeks, a reminder that I’m long overdue to try to pull together some thoughts about the Medicare Prescription Payment Plan, aka “smoothing” (also aka MPPP, M3P, etc.).
If you’re reading this, you know the concept: starting next year, Medicare beneficiaries can spread their out-of-pocket costs evenly throughout the year rather than being socked with deductible payments and coinsurance at the beginning of the year. It’s a nice, patient-friendly concept.
It’s also one that has a lot of weird nuances. Some of comes down to the simple math of how much the monthly payment is and how that might change over time. Stacey Dutsetzina had a great Health Affairs paper on this, and Jennifer Snow has a LinkedIn post looking at various scenarios. Both are worthwhile reads.
Some of the questions have to do with the varied nature of drug costs and the unpredictability of life. What happens if your drug regime changes during the course of the year? What if a beneficiary dies? How does that all get adjudicated?
My hope when I scrawled that note to myself was that I would just curate some good, smart, consumer-focused content and consider the job complete.
But — and here’s the rub — there isn’t really much in the way of good, smart, consumer-focused content.
It feels like AARP should be leading the charge here, but searching their site for “smoothing” gets you recommended undergarments and wrinkle cures. The results for “Medicare Prescription Payment Plan” are more relevant but hardly more useful. I couldn’t find anything on nytimes.com relating to smoothing. Ditto with USA Today. And Cigna.com.
I’m not being comprehensive, and I don’t want to suggest that there isn’t anything out there to help a senior get his or her brain wrapped around the Medicare Prescription Payment Plan. But most of what’s out there is kind of wonk-oriented, not aimed at the consumer. I’m sure there will be more chatter after Oct. 15, when open enrollment begins, but that process is stressful enough without introducing a new concept.
I linked to a page about “SEP Fields” yesterday — the idea that you can render something invisible by assuming it’s someone else’s problem — and I’m worried that smoothing is sitting right in the middle of a SEP field.
It’s not clear who has (or should have) the primary responsibility for informing the public here, and that lack of clarity is showing up. I don’t quite know where things go from here, but I suspect it’ll be bad news for anyone other than those shopping for shapewear.
I feel like I’m supposed to say something in advance of the presidential debate tonight. Certainly, there is some attention around drug pricing policy in the runup, notably this Washington Post piece.
But the reality is that neither candidate has done much to outline specific new policies and much of the coverage is merely a recitation of each candidate’s record. My suspicion is that — at best — we’ll get a couple of throwaway lines from each candidate about the IRA or international freeloading, and that will be it.
That said, there are fairly good odds that Medicare will be the most-mentioned policy topic at the debate: BetOnline has “Medicare” at +150 in the “Most Mentions: Policies” category. (“Deportation,” at +450, feels like a better gamble.)
Regardless, I’ll check back in tomorrow.
Elsewhere:
This American Medical Association report on PBMs is a fairly good one when it comes to clip-n-save stats. It breaks down the market share of the PBMs fairly well, but what I really like is the way that it quantifies vertical integration in the industry. Per AMA, 72% of Americans with a commercial or Medicare Part D drug plan are being served by an insurer that also owns the PBM. What could go wrong?
I probably don’t talk about international issues enough in the newsletter, but I’m tuning in more closely to the mpox crisis in Africa, which is beginning to morph into a story with a meaningful vaccine-price element. Bloomberg looked at the emerging issue, where vaccines cost $100+ and the traditional tools for driving those costs down (e.g. volume-based deals) don’t seem to fit well.Header image via Flickr user
Thanks for reading this far. I’m always flattered when folks share all or part of Cost Curve. All I ask is for a mention or tag. Bonus points if you can direct someone to the subscription page.
